Health Monitoring Systems conducted a pilot study of the MediCenter medication reconciliation system that showed improved medication list accuracy, increased nursing efficiency, and demonstrated clinical significance while offering a potential return on investment of $300,000.
Numerous healthcare quality organizations have identified medication administration as an area of improvement for patient safety. The Joint Commission has led the way with Patient Safety Goal #8, Medication Reconciliation. Although this quality initiative is of value to hospitals, implementation has been difficult.
The MediCenter service automates compilation of the patient’s home medication list by accessing prescription history from payers and pharmacies.
Are automated home medication lists effective in a clinical environment? A formal MediCenter study, conducted from January to March 2010 at a pilot hospital, demonstrated that they were. MediCenter improved medication list accuracy, increased nursing efficiency, and demonstrated clinical significance during the pilot period.
Improving Medication History Accuracy
The goal of compiling patient medication history is to avoid Adverse Drug Events (ADEs) and support diagnosis and treatment.
MediCenter achieves this goal. Nurses using MediCenter receive medication history for 75% of visits. For these patients, 95% of their current medications were correctly identified.
In contrast, a nurse following best practices and using a patient’s previous medication history from the hospital only identified about 70% of home medications.
When conducting a medication history interview with MediCenter, clinical staff members can uncover nearly 35% more medications for each patient, improving medication history accuracy.
Increasing Nursing Efficiency
The challenge facing the Joint Commission’s Patient Safety Goal #8 has been the inefficiency hospitals faced while implementing a thorough medication reconciliation process.
Anecdotal evidence describes 20, 30, and 40 minutes to compile medication history per patient. A 2008 survey conducted by Health Monitoring Systems of 40 hospitals indicated that the process could take 15 minutes.
Performing consistent medication history interviews at each entrance to a hospital has been identified as a best practice. Hospitals implementing this practice have struggled with a trade-off between efficiency and accuracy.
To achieve the same level of accuracy as with MediCenter, approximately 20 additional minutes of nursing time would need to be spent with each patient, following up with calls to family members, physician offices, and pharmacies.
As an additional confirmation of MediCenter’s utility, in-patient complied home medication history was compared against MediCenter results. The level of agreement between these two sources was comparable to what was observed with lists compiled in the ED and MediCenter.
Demonstrating Clinical Significance
MediCenter routinely provides an accurate medication history to clinicians efficiently, but are the results meaningful?
When asked, physicians are clear. Having knowledge of each and every medication is important. It is equally clear that a trade-off is made, balancing time to gather data against the value it provides. In general, all of the additional medications discovered with MediCenter are significant.
Specifically, MediCenter identified NSAIDs, controlled narcotics, cardiac drugs, anti-depressants, and antibiotics at rates greater than the 35% average. The following table illustrates the improvement in reporting when using MediCenter:
Another concern are ADEs due interactions with commonly administered treatments. Of the medications uncovered by MediCenter, 2 in 5 patients had an unreported medication that had a potential severe interaction with the most common treatments.
MediCenter results demonstrate that significant categories of medications are underreported and that ADEs can be reduced establishing clinical significance.